Beyond top-down approaches: Community Connexions as a multi-level, community-embedded model for health equity

Across high-income countries, public health systems struggle to address health inequities shaped by structural constraint and social inequity. Using focus group data from Birmingham, United Kingdom, this article examines how under-served communities experience and navigate public health systems in contexts of deprivation and super-diversity. The findings show how public health approaches shaped by top-down macro-level policy logics, and Western neoliberal micro-level assumptions about behaviour and choice, often fail to engage with everyday realities. Participants’ accounts highlight that health outcomes cannot be fully understood, nor health inequities effectively addressed, without foregrounding the meso level and recognising the critical, yet frequently overlooked role of the voluntary, community, faith and social enterprise (VCFSE) sector alongside macro- and micro-level influences. Participants called for stronger integration of VCFSEs within public health policymaking, emphasising their role in mediating access, building trust, and delivering culturally relevant support. In response, the article introduces the Community Connexions model, an innovative multi-level framework that repositions VCFSEs and healthcare providers at the centre of public health systems. By challenging siloed approaches, the model supports more horizontal, context-sensitive, and equitable forms of prevention and community-based care, offering a practical route for designing public health with communities, rather than for them.